Abstract
Background
Compared with other breast cancer subtypes, triple negative breast cancers (TNBC) are associated with higher recurrence rates and worse survival. Because of the aggressive nature of TNBC, outcomes may be more sensitive to delays in time to treatment. This study evaluates whether delays from diagnosis to initial treatment in TNBC impacts survival or locoregional recurrence (LRR).
Methods
Retrospective review of TNBC patients treated between January 2004 and January 2011 at an academic center was performed. Data collected included demographics, pathology, treatment, recurrence, and survival. Interval to treatment was defined as days from pathologic diagnosis to first local or systemic treatment. The t test, Cox regression, and Kaplan–Meier analyses were used to evaluate impact of time to treatment on overall survival and LRR.
Results
Median follow-up was 40 months for 301 TNBC patients. Mean interval to treatment was 46 ± 2 days. Higher initial stage yielded worse survival (p < .0001). Interval to treatment did not impact overall survival (p = .24), although there was a trend toward worse survival with delays of >90 days (p = .06). LRR was seen in 20 patients (7 %). Median time to recurrence was 15 months. Time to treatment was 38 ± 6 days for patients with LRR versus 44 ± 2 days without a recurrence (p = .37). Short delay in time to treatment did not impact LRR (p = .54).
Conclusions
In TNBC, a short delay from pathologic diagnosis to initial treatment does not appear to adversely affect survival or LRR. Appropriate time to perform evaluations such as genetic testing, imaging, or additional consultation can be taken to guide optimal treatment options.
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References
Bilimoria KY, Ko CY, Tomlinson JS, Stewart AK, Talamonti MS, Hynes DL, et al. Wait times for cancer surgery in the United States: trends and predictors of delays. Ann Surg. 2011;253:779–85.
Richards MA, Smith P, Ramirez AJ, Fentiman IS, Rubens RD. The influence on survival of delay in the presentation and treatment of symptomatic breast cancer. Br J Cancer. 1999;79:858–64.
Richards MA, Westcombe AM, Love SB, Littlejohns P, Ramirez AJ. Influence of delay on survival in patients with breast cancer: a systematic review. Lancet. 1999;353:1119–26.
Fisher ER, Redmond C, Fisher B. A perspective concerning the relation of duration of symptoms to treatment failure in patients with breast cancer. Cancer. 1977;40:3160–7.
Feldman JG, Saunders M, Carter AC, Gardner B. The effects of patient delay and symptoms other than a lump on survival in breast cancer. Cancer. 1983;51:1226–9.
Sainsbury R, Johnston C, Haward B. Effect on survival of delays in referral of patients with breast-cancer symptoms: a retrospective analysis. Lancet. 1999;353:1132–5.
Brazda A, Estroff J, Euhus D, Leitch AM, Huth J, Andrews V, et al. Delays in time to treatment and survival impact in breast cancer. Ann Surg Oncol. 2010;17 Suppl 3:291–6.
Sorlie T, Perou CM, Tibshirani R, Aas T, Geisler S, Johnsen H, et al. Gene expression patterns of breast carcinomas distinguish tumor subclasses with clinical implications. Proc Natl Acad Sci USA. 2001;98:10869–74.
Finnegan TJ, Carey LA. Gene-expression analysis and the basal-like breast cancer subtype. Future Oncol. 2007;3:55–63.
Onitilo AA, Engel JM, Greenlee RT, Mukesh BN. Breast cancer subtypes based on ER/PR and Her2 expression: comparison of clinicopathologic features and survival. Clin Med Res. 2009;7:4–13.
Park S, Koo JS, Kim MS, Park HS, Lee JS, Lee JS, et al. Characteristics and outcomes according to molecular subtypes of breast cancer as classified by a panel of four biomarkers using immunohistochemistry. Breast. 2012;21:50–7.
Nishimura R, Arima N. Is triple negative a prognostic factor in breast cancer? Breast Cancer. 2008;15:303–8.
Carey LA, Perou CM, Livasy CA, Dressler LG, Cowan D, Conway K, et al. Race, breast cancer subtypes, and survival in the Carolina Breast Cancer Study. JAMA. 2006;295:2492–502.
Ihemelandu CU, Naab TJ, Mezghebe HM, Makambi KH, Siram SM, Leffall LD Jr, et al. Treatment and survival outcome for molecular breast cancer subtypes in black women. Ann Surg. 2008;247:463–9.
Trivers KF, Lund MJ, Porter PL, Liff JM, Flagg EW, Coates RJ, et al. The epidemiology of triple-negative breast cancer, including race. Cancer Causes Control. 2009;20:1071–82.
Lowery AJ, Kell MR, Glynn RW, Kerin MJ Sweeney KJ. Locoregional recurrence after breast cancer surgery: a systematic review by receptor phenotype. Breast Cancer Res Treat. 2012;133:831–41.
Dent R, Trudeau M, Pritchard KI, Hanna WM, Kahn HK, Sawka CA, et al. Triple-negative breast cancer: clinical features and patterns of recurrence. Clin Cancer Res. 2007;13:4429–34.
Voduc KD, Cheang MC, Tyldesley S, Gelmon K, Nielsen TO, Kennecke H. Breast cancer subtypes and the risk of local and regional relapse. J Clin Oncol. 2010;28:1684–91.
Fedewa SA, Edge SB, Stewart AK, Halpern MT, Marlow NM, Ward EM. Race and ethnicity are associated with delays in breast cancer treatment (2003–2006). J Health Care Poor Underserved. 2011;22:128–41.
Kaufman CS, Landercasper J. Can we measure the quality of breast surgical care? Ann Surg Oncol. 2011;18:3053–60.
Malin JL, Schneider EC, Epstein AM, Adams J, Emanuel EJ, Kahn KL, et al. Results of the National Initiative for Cancer Care Quality: how can we improve the quality of cancer care in the United States? J Clin Oncol. 2006;24:626–34.
Moran MS, Goss D, Haffty BG, Kaufman CS, Winchester DP. Quality measures, standards, and accreditation for breast centers in the United States. Int J Radiat Oncol Biol Phys. 2010;76:1–4.
Raval MV, Bilimoria KY, Stewart AK, Bentrem DJ, Ko CY. Using the NCDB for cancer care improvement: an introduction to available quality assessment tools. J Surg Oncol. 2009;99:488–90.
Kaufman CS, Shockney L, Rabinowitz B, Coleman C, Beard C, Landercasper J, et al. National Quality Measures for Breast Centers (NQMBC): a robust quality tool: breast center quality measures. Ann Surg Oncol. 2010;17:377–85.
Landercasper J, Linebarger JH, Ellis RL, Mathiason MA, Johnson JM, Marcou KA, et al. A quality review of the timeliness of breast cancer diagnosis and treatment in an integrated breast center. J Am Coll Surg. 2010;210:449–55.
Chlebowski RT, Chen Z, Anderson GL, Rohan T, Aragaki A, Lane D, et al. Ethnicity and breast cancer: factors influencing differences in incidence and outcome. J Natl Cancer Inst. 2005;97:439–48.
Montagna E, Bagnardi V, Rotmensz N, Viale G, Renne G, Cancello G, et al. Breast cancer subtypes and outcome after local and regional relapse. Ann Oncol. 2012;23:324–31.
Zaky SS, Lund M, May KA, Godette KD, Beitler JJ, Holmes LR, et al. The negative effect of triple-negative breast cancer on outcome after breast-conserving therapy. Ann Surg Oncol. 2011;18:2858–65.
Abdulkarim BS, Cuartero J, Hanson J, Deschenes J, Lesniak D, Sabri S. Increased risk of locoregional recurrence for women with T1-2N0 triple-negative breast cancer treated with modified radical mastectomy without adjuvant radiation therapy compared with breast-conserving therapy. J Clin Oncol. 2011;29:2852–8.
Parker CC, Ampil F, Burton G, Li BD, Chu QD. Is breast conservation therapy a viable option for patients with triple-receptor negative breast cancer? Surgery. 2010;148:386–91.
Adkins FC, Gonzalez-Angulo AM, Lei X, Hernandez-Aya LF, Mittendorf EA, Litton JK, et al. Triple-negative breast cancer is not a contraindication for breast conservation. Ann Surg Oncol. 2011;18:3164–73.
IOM committee calls for complete revamping of health care system to achieve better quality. Qual Lett Healthc Lead. 2001;13:14–5.
Acknowledgment
The authors wish to thank the David M. Crowley Foundation for their support of this research.
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Eastman, A., Tammaro, Y., Moldrem, A. et al. Outcomes of Delays in Time to Treatment in Triple Negative Breast Cancer. Ann Surg Oncol 20, 1880–1885 (2013). https://doi.org/10.1245/s10434-012-2835-z
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DOI: https://doi.org/10.1245/s10434-012-2835-z